When Noam Cohen began equine therapy four years ago, he was completely paralyzed. After finally waking from a coma that lasted several months after he sustained severe injuries in a car accident in 1997, he couldn’t even move his head.

Yoav Green, Cohen’s instructor at the Therapeutic Riding Center of Israel (TRCI), recalled that it took four staff members – one leading the horse and two ‘side-walkers’ flanking Cohen’s horse Stabella on either side – to stabilize him in his first lesson.

But all that has changed. “In the last three weeks, I have only had to hold him by the elbows,” said Green elatedly, after a recent session with Cohen.

Green pulled Cohen off the horse and helped him feed her a post-lesson carrot – a tradition that, according to Green, not only establishes a bond between rider and horse, but also provides the necessary motivation for Cohen to use his arm and hand muscles.

“In our next step, he will hold himself up using his hands and his back and I will remove my hands from him completely,” he says as he waves goodbye to Cohen, who by now has been lifted into the ambulance that takes him home,

For Cohen’s caregiver, who has been with him since the accident, the riding therapy has been nothing short of a miracle. “This therapy has helped him so much,” she says with a smile. “It helped him start to look around, to sit more straight, and to be more stable. Now, he can move his hand, he can move his head from right to left, and most remarkably – he can stand.”

Cohen is one of over 600 patients – with handicaps ranging from blindness, deafness, CP, ALS, Asperger Syndrome, Rett Syndrome, and brain damage, to major or minor physical, psychological, mental, emotional, behavioral, or confidence problems, to high risk teens and kids with special needs or learning disabilities – who receive treatment at TRCI’s innovative Equine and Dog Animal Assisted Therapy (AAT) programs.

Founded in 1989 by Anita and Giora Shkedi as the Therapeutic Riding Club of Israel, the non-profit organization changed hands and became the Therapeutic Riding Center of Israel in 2000 and moved from its original space in moshav Beit Yeoshua to its current 40-dunam state-of-the-art facility in Tel Mond, with an indoor riding arena of 2,000 square meters

Anita Shkedi is single-handedly responsible for the development of therapeutic horse back riding in Israel. When she and her husband Giora started the non-profit organization in 1989, all of the equipment and horses were privately owned by her, which she graciously donated for use as part of the day-to-day operations of the club.

The center currently boasts a staff consisting of social workers, physiotherapists, occupational therapists, psychologists, medical doctors, seven therapeutic riding instructors, three dog therapy instructors, 23 horses, 20 working dogs, and soon, several small animals such as rabbits and guinea pigs, who altogether provide patients with a total of 1,800 treatments per month.

In 1989, Anita Shkedi also established the prestigious National Association for Horseback Riding at Israel’s Wingate Institute, which has a worldwide reputation for producing top AAT professionals. This association is now located at INTRA – the Israel National Therapeutic Riding Association, near Beit Yanai, which was founded by the Shkedis in 2000.

What’s the secret of TRCI’s success? According to their Therapeutic Program Director Maureen Tal, it is the center’s unique combination therapy for each patient.

“We treat patients holistically,” says Tal, who explains that when a patient first comes to the center, his or her guardians first meet with a social worker. They help determine the goals of treatment and the most effective combination of therapies – among them, rehabilitation, physiotherapy, hydrotherapy, communication therapy, speech therapy, occupational therapy, reflexology, yoga, judo, various types of massage, and of course AAT – to achieve those goals.

“Each patient has his own requirements and each needs his own, unique treatment plan,” she told ISRAEL21c. “Our objective is to determine the complementary combination for each patient.”

When it comes to Equine Assisted Therapy (EAT) itself, the specifications are even more precise – each patient is fitted for a horse, equipment, an instructor, and a method.

“When you decide what horse to give to a rider, it’s like putting a shoe on a foot,” says Green, who explains that the basic idea behind EAT is to use the movement of the horse to activate the patients’ blood and respiratory systems.

“Especially with patients who are paralyzed, their systems tend to get ‘stuck’. Equine Assisted Therapy directly influences all the balance systems in the human body, because the horse’s and the client’s bodies are constantly trying to find a balance between them,” adds Tal. “A lot of the exercises with the horse help improve the clients’ balance.”

How do instructors teach balance? Green explains that he has a patient sit on the horse, and lets him lean from side to side, forward and back, before pulling him straight so that the patient learns to feel the difference between being instable and being stable.

“Normally, the body learns from the brain, which sends messages to the body,” explains Green. “But in the case where there is something wrong with the brain of a patient, the body can learn also from its own external experience.”

But EAT does not result exclusively in physical benefits. There is an equally significant psychological impact on patients. “When you take a person who sits all his life on a wheelchair and sees the world from about three feet. and you put him on a nearly six foot horse, he sees the world from above,” explains Gidon Ra’anan, the center’s head administrator. “Sitting on the horses gives patients a different perspective, one that infuses them with pride and a sense of power.”

The center’s secondary form of AAT, Dog Assisted Therapy (DAT), takes place primarily at the on-campus kennel, which was opened in 2001. Over 200 patients are enrolled in the DAT program at TRCI. “The program with the dogs is completely different,” says Kennel Director Hanni Kovalsky. “Work with horses is focused primarily on physical rehabilitation. Here, we work as much on the physical side as we do on the emotional side. Through the dog, you can reach certain areas you can’t reach with the horses.”

To begin, patients benefit from the fact that they get an immediate response from the dogs, which are trained to follow simple commands including sit, lie down, heel, and come. One patient, a 12-year-old girl with autism, who never spoke a word in her life, spoke for the first time to her dog at TRCI. “She realized, hey, maybe it’s worth talking, because someone is listening to me,” explains Kovalsky.

In a similar case, a dog at TRCI provided the motivation for one patient – a three-year-old boy who was so sensitive to touch that he couldn’t touch his parents – to hug them. Says Kovalsky, “first he hugged the dog then he hugged his parents.”

Dogs are also useful in motivating CP patients who have trouble walking, to walk. “A child who is in physiotherapy for four or five years gets sick of the routine exercises and stops moving,” she says. “But with a dog, the child has a non-therapeutic incentive to walk or reach out – namely, to pet or touch the dog.”

DAT has also helped several high-risk youth become less aggressive. Working with mixed groups of high-risk youth and CP kids has proved particularly successful. “It’s amazing. These violent kids take their masks off – they don’t have to be tough anymore – and you see a side of them you never knew existed.”

Teams of up to 10 dogs also visit elderly in retirement facilities across the country. “The dogs become their babies. They pet and groom and feed them,” says Kovalsky. “For these people who are always being taking care of and told what to do, this is a chance for them to take care of someone else and to tell someone else what to do.”

With DAT, the key idea is that dogs are a source of unconditional love. “Dogs love unconditionally. It doesn’t matter what you look like; dogs read people and show affection for them, no matter what. That is the most amazing thing about them.”

Most of the dogs in the DAT program were donated to the center, or collected as strays. More complicated, explains Ra’anan, is the acquisition of horses for the EAT program. Like Stabella, most horses at the center are Haflinger, or ponies. The main criterion is that they are short (to make it easier for patients to mount and dismount and for side-walkers to be able to reach up to patients), wide and sturdy (to provide a stable seat for patients), and perhaps most importantly – that they have a calm and friendly disposition.

The success of both the EAT and DAT programs is contingent not only on the quality of animals but also on an overarching belief in the patients’ ability to improve. “In our profession, you have to believe,” says Green. “With [Cohen], I believe that he is going to sit alone. And he is going to sit alone. I promise you – if you come here in another year, he will be sitting alone. I will be near him, but I won’t have to hold him. I can’t explain how it is going to happen, but it is going to happen. That’s for sure.”

A similar belief in the future motivated the establishment of the center’s new Van Leer Foundation Coexistence Program, in which a staff of Israeli Jewish and Arab professionals gives therapies (through horses and small animals) to Arab CP children and promotes awareness among Arab professionals of these alternative forms of therapy.

The center, along with the Zoological Department of the University of Tel Aviv and the University of Gent, also recently launched a joint educational exchange program with therapeutic professionals from Belgium.

“There is no place in Belgium like this, where all different therapies are centered in one location,” says Paul Vloage, an intern on exchange at TRCI. According to Vloage, the center is also famous for its hippotherapy program – a special EAT technique designed for children with severe CP in which the instructor sits on the horse with the patient.

“This is another thing that makes this place so special.”

At $20 for a group session, $25 for a private 30-minute session, and $35 for a session with a special therapist – prices which only cover 60-70% of the actual cost of the programs – TRCI is not accessible to all who need it. That’s why the center invests a lot of time and energy into fundraising.

“The idea of the founders and the donors to this place was to open it to as many people as possible,” says Ra’anan, who explains that in the last year, the center has raised enough funds to provide EAT to a new group of blind children who couldn’t afford to pay anything at all.

“If you think this therapy is right for someone you know, please contact us. We”re here to help.”